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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417055
Report Date: 09/26/2022
Date Signed: 09/26/2022 01:37:29 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/22/2022 and conducted by Evaluator Teodoro Trujillo
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20220922102725
FACILITY NAME:LEVEL UP MONTESSORI SAN JOSEFACILITY NUMBER:
434417055
ADMINISTRATOR:SAPNA RASTOGIFACILITY TYPE:
850
ADDRESS:4868 SAN FELIPE ROAD #130TELEPHONE:
(408) 718-3316
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:70CENSUS: 8DATE:
09/26/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sapna RastogiTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Unlicensed care is being provided.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Teodoro Trujillo and Susy Cervantes, met with Sapna Rastogi, Site Director, for a complaint investigation and notified the director of the reason for the visit. Present were site director and 2 teachers with 8 children in care: all preschool age. During visit, owners Manish Rastogi and Sandhya Agarwal arrived.

On September 22, 2022 an unlicensed complaint was submitted to the San Jose Regional Office. LPAs were provided with staff and children files. LPAs conducted staff interviews.

Type A deficiencies was issued during today's inspection.

LPAs Teodoro and Susy Cervantes informed facility representative Sandhya Agarwal that this report dated 09/26/2022 document(s) one (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPAs Teodoro Trujillo and Susy Cervantes informed the lacility representative Sandhya Agarwal to provide a copy of this licensing report dated 09/26/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted with Sandhya Agarwal co-owner.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Citations on this Visit Report are Under Appeal!

Control Number 07-CC-20220922102725
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LEVEL UP MONTESSORI SAN JOSE
FACILITY NUMBER: 434417055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/27/2022
Section Cited
HSC
1503.5(a)(1)
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1503.5 ... The facility is providing care or supervision, as defined by this chapter or the rules and regulations adopted pursuant to this chapter. This requirement was not met as evidence by:
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Applicants will submit a completed application the San Jose Regional Office by close of business 09/27/2022.
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based on record review and observation, facility license is currently pending and not active, which poses an immediate risk to the health, safety, and personal rights of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2